Saturday, February 14, 2009

PA's and NP's in my world

This has been on my mind and Happy Hospitalist's post got me thinking about the whole thing.

I am board certified in my field and I completed a 2 year hospital based residency, but nothing that compares to physician residencies. Because of my training and my interests I see a fair number of medically compromised patients. There are times I need to consult with my patient's primary care physician before embarking on a proposed treatment plan. When I consult with a physician it is not to ask permission to treat the patient, but to see if there are any potential landmines with my choice of meds or procedures. There have been a few times as of late that I have gotten a reply from a PA. I'm sorry, but I will not accept those consult replies.

My treatment plan will be based on my judgement and the input of the patient's physician not a mid level provider. When the patient is in my office, I am wholly responsible for their care and the outcome of any treatment. I could not defend any decision made by one of my colleagues based on input by anyone other than an MD or DO and I don't think it would be defensible in court.


Tanya said...

May I just make a comment regarding PA's from the perspective of a patient? I had to see the PA occasionally in my oncologist's office and I developed an immense disliking for her from the get-go. She wanted to write a scrip to treat what I had told her was a minor side effect that I could deal with without drugs. I asked her how the new drug would interact with all the stuff I was currently taking and she said, "Don't worry about it. I prescribe this to all the old ladies and they love it". I was 49 years old, not in my opinion an old lady. And I didn't give a rat's behind how other patients handled the drug. And she didn't have a clue what other drugs I was taking. This is why I dislike PAs, and why I told the onc I would change doctors instead of seeing her again. This is the difference between a person who has an MD and a person who is a PA. Fortunately for me, the doctor dropped the PA and I didn't have to get sub par treatment from her on subsequent visits. I suppose a PA has his place in the medical world, for routine treatment. Unfortunately, even a "routine" visit can become something serious if an experienced doctor sees something out of the ordinary with his patient-I have a feeling a PA would not pick up on a serious problem. Sorry for the long post-I feel strongly about this.

DocV said...

I know a number of very kind, compassionate PAs and NPs and have worked closely with them at several duty stations. My concern is not with the breadth of their knowledge but the depth.

Tanya said...

While I found the PA's age comments annoying, the fact that she didn't know what drugs I was taking, and thus could not address the issue of interaction with a new prescription, and didn't think it was important enough to look into, speaks volumes about the depth of her knowledge and ability to treat me properly, and that was my main concern about seeing her rather than the doctor.